title: Mortality after uveal and conjunctival melanoma: which tumour is more deadly?
abstract: OBJECTIVE
  We aimed to model and compare mortality rates for uveal melanoma (UM) and conjunctival melanoma (CM) by adjusting for differences in tumour size and local recurrence.
  
  
  METHODS
  Population-based mortality data for 240 and 85 patients with primary UM and CM and 91 and 23 patients with disseminated UM and CM, respectively, were compared with cumulative incidence analysis. Cox proportional hazards multivariate regression with time-dependent variables was used to adjust for differences in tumour diameter, thickness and recurrence rates.
  
  
  RESULTS
  The 10-year cumulative incidences of metastatic death from UM and CM were 39% (95% confidence interval [CI] 33-45) and 32% (95% CI 21-44), respectively. After adjusting for tumour size, risk of death from CM was higher than from UM (hazard ratio [HR] 1.9; p = 0.039). Additional adjustment for more frequent local recurrence of CM diminished the difference (HR 1.5; p = 0.25). Survival periods after systemic metastasis of UM and CM were comparable (median 8 months).
  
  
  CONCLUSIONS
  Clinical observations show longer survival after primary CM than after primary UM. This reflects the smaller average size of CM. However, a primary CM of a given size is more deadly than a UM of equivalent size because primary CM tends to recur after treatment and, possibly, because additional lymphatic dissemination occurs with CM.
authors.affiliation: Department of Ophthalmology, Helsinki University Central Hospital, Finland. emma.kujala@hus.fi
authors.forename: Emma
authors.initials: E
authors.lastname: Kujala
authors.forename: Seppo
authors.initials: S
authors.lastname: Tuomaala
authors.forename: Sebastian
authors.initials: S
authors.lastname: Eskelin
authors.forename: Tero
authors.initials: T
authors.lastname: Kivelä
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003230:Conjunctival Neoplasms / Q000401:mortality* / Q000473:pathology / Q000556:secondary; D006801:Humans; D053208:Kaplan-Meier Estimate; D008545:Melanoma / Q000401:mortality* / Q000473:pathology / Q000556:secondary; D008875:Middle Aged; D015233:Models, Statistical; D009364:Neoplasm Recurrence, Local / Q000401:mortality; D016016:Proportional Hazards Models; D014604:Uveal Neoplasms / Q000401:mortality* / Q000473:pathology / Q000556:secondary; D055815:Young Adult